A National Pharmacy First Scheme

One of the most significant challenges the UK currently faces is prompt and efficient access to healthcare. After having come out of Covid-19 lockdowns, the NHS is facing many difficulties, in particular, backlogs and staffing issues. It has become evident that in many parts of the UK, accessing GP appointments has become difficult, and many people are having to wait several months for hospital appointments. One way in which pressures can be relived on GPs, and other healthcare professionals is through the creation of a fully-funded Pharmacy First Scheme, implemented at a national level throughout England. This would mean patients could consult a pharmacist about minor illnesses, and receive treatment for free. Pharmacists are highly-trained healthcare professionals, who study a four year masters degree in pharmacy at university (MPharm), and complete a foundation year with an examination, in order to join the General Pharmaceutical Council (GPhC) pharmacist register. Much of the MPharm degree focuses on the management of minor illnesses, and the safe and effective use of medicines. The degree has great emphasis on clinical skills, such that from 2026, every newly registered pharmacist graduated from the MPharm degree will automatically become a qualified Independent Prescriber (IP), meaning they can prescribe autonomously for any condition within their clinical competence, excluding three controlled drugs for the treatment of addiction. Pharmacists are also trained to recognise when a situation is outwith their competence, and can refer patients to other healthcare professionals such as GPs and Dentists, or NHS 111 advisors.

A Pharmacy First Scheme is a policy which encourages patients to consult a pharmacist for any minor illnesses, before seeing a GP. Every pharmacy offering this service would be contractually required to have a private consultation room which most pharmacies already have, and this would allow patients to consult with the pharmacist in a private setting. In many European countries, such as France, pharmacies are normally the first place people go to for advice around minor illnesses. Pharmacies are ideal places for people to access treatment for minor illnesses, as they are much more local than many other healthcare settings, and patients can in most cases consult pharmacists without an appointment. Many pharmacists working in hospitals and GP surgeries already run minor ailment clinics, hence there is a very feasible opportunity for this to be rolled out in community pharmacies. As a result of future pharmacists automatically becoming Independent Prescribers, this puts pharmacists in an ideal position to give advice around and treat minor illnesses, such as earache and urinary tract infections. However, in order to provide such a service, pharmacies would have to receive additional funding in order to provide this NHS service. Scotland has adopted a Pharmacy First Plus Scheme in 2020, which pays pharmacies with an IP Pharmacist providing the service £2000/month, and has completed over 3 million Pharmacy First consultations to date. The scheme provides clear guidance around conditions which pharmacists can provide treatment for, and it has proven to be a massive success. However, it may be the case that in larger pharmacies with multiple IP Pharmacists, further funding would be required to maintain the service. The Pharmaceutical Services Negotiating Committee (PSNC) estimates that 40 million GP appointments per year (totalling 8 million hours annually) could be take over by pharmacies, and this is forecast to save NHS England £640 million annually, taking into account the cost of running the policy. However, perhaps this policy would be more effective if community pharmacy computer systems are better integrated with NHS records, so that pharmacist could seamlessly access people’s healthcare records, and add any additional information to patient notes. A Pharmacy First Scheme implemented in England would allow patients, such as people with a urinary tract infection, to receive treatment to quickly relive their pain, without having to wait a much longer time for a GP appointment.

To summarise the advantages of the Pharmacy First Scheme:

• The policy would free up more time for GPs to attend to other consultations, including 40 million appointments totalling 8 million hours, per year

• Pharmacists are currently under-utilised resources in this regard, and have extensive training around the

management of minor illnesses, and the safe and effective use of medicines

• The service can provide a clear mechanism by which pharmacists can assess and refer patients to other

healthcare professionals such as GPs and Dentists, or and NHS 111 advisor

• It makes effective use of new cohort of IP pharmacists graduating from 2026

• This is estimated to save the NHS £640 million annually

• It would allow patients to access treatments much more quickly for simple conditions

• Pharmacy First consultations would be very accessible to members of the public, on a local level, and without the need for an appointment, and this would directly combat the growing inequality in access to healthcare in the UK